Cambodia is increasingly integrating with the region and has enjoyed a decade of macroeconomic stability and growth. However, its progress in meeting the Millennium Development Goals is uneven.
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The royal Cambodian government (RCG) has
achieved remarkable progress in recent years in reducing the
poverty rate by more than half. However, the majority of
those... Show More + escaping from poverty only did so marginally and
remain largely near-poor and still highly vulnerable to the
slightest of shocks. One of the most critical factors in
enabling the poor to escape from poverty, and not only
remain non-poor but go on to prosper, lies in ensuring
higher levels of health welfare in these households. This is
especially important in rural areas, where most of
Cambodias poor reside and where health indicators show a
stark divergence with those for urban areas. If poverty is
to continue to decline apace, and the gap between rich and
poor is to continue to narrow, then the RCG will need to
ensure that poor and near-poor peoples health care is
greatly improved such that they can make the most of the new
opportunities in education and employment that are now
becoming available. With significant improvements in some
health indicators over the past decade, the major challenges
in health care going forward are now becoming clearer. These
include: making a breakthrough in tackling high levels of
child mortality and child malnutrition; addressing equity
more effectively in health service provision and health
spending, through pro-poor targeted programs and
improvements in the coverage and rates of use of health
equity funds (HEF); and the improved monitoring of
unregulated private providers of medication used by the
majority of the poor. In addition, another crucial step
forward will be providing adequate financing and ensuring
the implementation of Cambodias first national social
protection strategy (NSPS). Show Less -

Non-communicable diseases (NCDs) are a
set of chronic diseases, including cardiovascular disease,
cancer, chronic respiratory disease, and diabetes that are
on the rise... Show More + in Cambodia. Meanwhile, injuries include those
due to traffic accidents, which are becoming a major source
of mortality and morbidity in Cambodia. NCDs are increasing
in Cambodia as a result of smoking, unhealthy diet, harmful
use of alcohol, and physical inactivity, all resulting in a
sharp increase in the rates of obesity and high blood
pressure. NCDs are affecting Cambodians in their productive
years. Over half men and over a third of women dying from
NCDs are younger than 60 years. The high cost of long-term
health care and medicines, along with loss of income, pushes
many Cambodian families deeper into poverty. It also
overburdens the country's health system, constraining
efforts to improve maternal and child health and tackle
infectious diseases. Because of the nature of NCDs, which
are rooted in multiple causes, strengthening the health
system alone will not reduce the burden of NCDs. Many of the
actions needed to prevent and control these diseases require
the participation of numerous ministries and government
agencies, as well as the private sector. For Cambodians to
continue enjoying the fruits of economic growth, a strong
commitment by the government, the people, and the
international community is becoming increasing important.
Improved coordination among all ministry of health (MOH)
task forces will maximize financial and human resources and
help implement priority NCDI-related interventions as part
of, and not separate from, other ongoing programs. The
application of the measures will benefit from clear
procedures for joint planning, programming, budgeting,
training, reporting, and monitoring and evaluation (M and E)
of all programs. Show Less -

It is already well known that the main
provider of primary health care (PHC) in Cambodia is the
private sector and that only one in three patients visits
the public... Show More + sector for out-patient care. However, data on
Cambodia's health market composition, the dynamics of
seeking health care, and the quality of health care in the
private health sector are scarce. For example, there is
almost no information on the differences in the quality of
care between the public and private sectors, and between
licensed and unlicensed providers. In order to remedy these
knowledge gaps, two studies were undertaken early in 2013.
The first aimed to look at health markets focusing on: (i)
the roll-out of Specialized Operating Agencies (SOAs), and
(ii) the roll-out of Health Equity Funds (HEFs). The second
study aimed to measure the quality of health care across the
sector. The findings of the two studies suggest that
traditional healers, such as Kru Khmer/witch doctors, shops
selling pills and traditional birth attendants (TBAs),
account for half of total rural health care providers,
followed by private and public providers. Health system
utilization indicates that 65 percent of all primary health
care visits were to the private sector, although 60 percent
of hospitalizations took place in public facilities.
Possessing an HEF card increases health seeking towards the
public sector to 34 percent (up from 15 percent), but only
46 percent of the poor have such cards. Half of women
deliver their babies at home, and of those only 11 percent
are attended by skilled medical personnel, while 88 percent
are assisted by TBAs. Only 54 percent of private providers
have formal training. Given the high utilization of the
private and non-medical sectors, it seems likely that a
large proportion of patients receive inadequate care, in
particular from informal non-medical providers. Show Less -

Cambodia has faced daunting challenges
in rebuilding its health workforce following the Khmer Rouge
genocide of 1975-79, during which about 90 percent of health
professionals... Show More + perished, and the period of civil war that
then continued until the 1990s. Today, government salaries
for medical workers remain low and most public sector health
professionals depend on a combination incentive payments
financed by government or development partners, income from
providing health services outside their public sector jobs
in the private sector, or by seeking non-medical second
jobs. Although public health services should be relatively
low cost or free, evidence suggests that many public sector
health workers request gifts or payments. A variety of
health financing and incentive schemes have been adopted
over the years since the 1990s. With a view to improving
service delivery in the health sector, the World Bank
recently undertook a study to inform policies on: the
compensation of public health workers; the management,
motivation and incentives for public health workers; how to
manage the existence of dual practice; and key reforms to
financial initiatives such as Health Equity Funds (HEFs) and
Special Operating Agencies (SOAs), both of which have an
important impact on health workers. The resulting findings
are important in reforming Cambodias human resources for
health (HRH) policies and providing solutions to enable
Cambodia's health sector to play its full role in
helping Cambodian citizens to fulfill their potential.Show Less -

Ratings for the Avian and Human
Influenza Control and Preparedness Emergency Project for
Cambodia were as follows: outcomes were moderately
satisfactory, the risk to... Show More + development outcome was
substantial, the Bank performance was moderately
satisfactory, and the Borrower performance was satisfactory.
Some lessons learned included: there is also an issue with
attribution when dealing with changes in the number of
cases. For example, one of the initial key indicators in
this project (the number of cases of avian influenza in
peri-urban commercial poultry) had to be dropped because no
new cases were detected in this sector during the course of
the project. This was coincidental and not attributable to
gains from project activities. Procurement and financial
management arrangements for the engagement of the UN
agencies in an emergency disease response project should be
clearly established at the corporate level in advance. One
of the crucial issues that remains to be addressed in
Cambodia but for which some background work has been
conducted (such as improved legislation and training in
biosecurity for villages) is the weak control over poultry
movements. Until such time as there is better control of
movement of poultry within Cambodia and across borders
disease outbreaks will recur. Limited controls on movement
of other types of livestock also threaten the health status
of livestock in the country. Detailed case investigations
and monitoring provide opportunities to reduce the
probability of emergence of a pandemic agent. The work
undertaken by officers in Health Departments following
detection of human cases provided the best possible chance
of detecting any evidence of human to human transmission of
the virus therefore allowing measures to be implemented to
prevent its spread. Show Less -

The development objective of the Second
Health Sector Support Program Project for Cambodia is to
support the implementation of the government's health
strategic plan... Show More + 2008-2015 to improve health outcomes through
strengthening institutional capacity and mechanisms by which
the government and development partners can achieve more
effective and efficient sector performance. The second
additional financing (AF2) will provide financing to sustain
and consolidate gains in the health service coverage under
the program, particularly for the poor. The additional funds
will fill a nine month financing gap for health equity funds
(HEFs) and service delivery grants (SDGs) between July 1,
and March 31, 2015. It will also allow time for the World
Bank, Australia, Korean International Cooperation Agency
(KOICA), and the Ministry of Health (MOH) to develop the
next phase of support to the health sector and align with
the future investment operations of the third health
strategic plan which is expected to commence implementation
in 2016. The program's results framework has been
revised to only include targets that can be attributed to
the programs activities and can be measured. In some cases,
the type of indicator has also been revised, such as from
program development objective (PDO) level to intermediate
level and vice-versa. Show Less -